HomeMy WebLinkAboutHomestead_McEllhineyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (8014 -03)
Prescribed by the Department of Local Government Fetance
INSTRUCTIONS: See revorse aids W 1159 iubucborro.
FORM �� YEAR
HC10
F1 I! -
I (we) Y r�+1.d/ - Y ( / l - certify that on the 1 st day of March, 20
1 (We) occupied as our principal place of residence the following described real property for which a H estead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract qc nL
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property oIfISO�j �;Qj1n1df ter a conRITPR
a.
NTRACT- RECORDED.='';--,. �z` 3-. i; da; E- :,;t,'T'4T`�-`���:v�i3�"� ='"�
If buying on contract, Fee Supple owners name
Recorder's office where contract is recorded Record number Page
' .Z. ,rt "ar�sF: -a_'e—
`'r�.-i' '� °,.+:P,ROFERT,Y,-DESCRIP.TION
County
Township
Taring district (city, town, township)
P cel number
_
Leg IF. 2 s the property in question:
�_,,,)�
Dol C•
1 ❑ Real property ❑ Mobile Home (LC. 6:1.1 -7)
If any portion of-the residenflal structure or the larld not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
U - 000.
zsr r, :w`a:' �]"'yE' 's.?� r` 1' gr�i a =-:�f' d >
.A�SSEVSSOR USE ONLY'}°
County
Township
County Township
hereby certify the above statements are true, correct and complete.
4r' of claimant
Address (number and street, city, stale, ZIP code)
zsr r, :w`a:' �]"'yE' 's.?� r` 1' gr�i a =-:�f' d >
.A�SSEVSSOR USE ONLY'}°
b r .3>.•�i:
��TRl1Ei
AT 100 %OF'TTVVALUE�
-; w.+
e - k:
iS.:n4 ".-..9 .. c e
s.Ns.NAE -
�''N VALUE���'
� e .5.. .E
Land not exceeding 1 (one) acre immediately
rj(�y�.
surrounding residential improvements.
--
Other land
l21
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)``�*:ei
'Residential improvements crMnua ly
Assessed AMp1° /Manut a duped yWe,q ll
Garage
(5)
��yyC�,�•fy.•. ¢S ��y F
Other improvements
6V"
-r'?=
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of V2 Homestead
Valuation or 535.000
Dale signed